Provider Demographics
NPI:1669292272
Name:NDAYISHIMIYE, CLOVIS
Entity type:Individual
Prefix:
First Name:CLOVIS
Middle Name:
Last Name:NDAYISHIMIYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 CLIMBING ROSE PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-7047
Mailing Address - Country:US
Mailing Address - Phone:371-772-6813
Mailing Address - Fax:
Practice Address - Street 1:5139 CLIMBING ROSE PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-7047
Practice Address - Country:US
Practice Address - Phone:371-772-6813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care